“Embracing the truth that all things inevitably must end encourages us not to wait in order to begin living each moment in a manner that is deeply engaged.” ~ Frank Ostaseski
Touch is the first sense to develop in our bodies and may be the last sense to fade.
Touch is our instinctive form of communication. When we are born we discover the people and objects around us through touching and develop our physical relationship with our bodies through tactile exploration.
Touch is as natural a need as food and water. In the 13th century a study was performed by the German Emperor Frederick. The Emperor was curious to know what language children would speak if they were raised without hearing any words at all. The nurses were instructed to feed a group of infants, but not touch or talk to them. The infants never learned a language. They all died before they could speak. Frederick unwittingly made an important discovery: Tactile stimulation can be a matter of life and death.
https://www.digma.com/digma-images/video-scripts/fredericks_experiment.pdf
Why Touch?
As confirmed by Tiffany Fields, Director of the Touch Research institute at the Miami School of Medicine, a simple touch of a hand on the shoulder or an arm around the waist can:
- Lower blood pressure
- Stabilize heart rate
- Stimulate the release of endorphins, the body’s natural pain suppressors
How does the simple act of touch have such a profound effect on another living being? There are as many as 5 million touch receptors in the human skin. These receptors send messages along the spinal cord to the brain. Providing care through massage and intentional touch literally transmits messages to the receivers brain.
https://www.researchgate.net/scientific-contributions/39335193_Tiffany_Field
How is Massage in Hospice Different from Typical Massage?
Massage Therapy in Hospice requires a physicians order. Massage is nurturing, deliberate and provides the comfort and tranquility a dying person deserves.
As the physical and mental functions of the hospice patient slow down so should the approach of care. Typical massage such as deep tissue or hot stone massage is not appropriate at end of life when the patient is in a fragile state.
The massage may take place wherever the patient is most comfortable. This could be a chair, a bed or a sofa. Transferring or adjusting location may be unsafe and possibly exacerbate pain and/or confusion.
Presence and intention are most significant when working with the dying. Massage is delivered slowly, gently and deliberately. Techniques may include, stroking, soft compressions, rhythmic movements, very gentle kneading and holding. Sometimes a gentle lift and reset of the extremities may produce relief.
Each visit is tailored to meet the ever-changing needs of the patient. Often, the massage is focused to one or two areas of the body such as the head or the feet. The length of each session varies according to individual needs and response.
These focused sessions often produce comfort, relaxation, improved sleep, ease of tense muscles and feelings of being cared for and loved.
Dying persons are vulnerable. This depth of vulnerability requires the practitioner to create a safe environment or container in which the dying person feels that his or her vulnerability is witnessed, validated and honored. ~ Irene Smith, Everflowing
Benefits for the Dying
- Non-pharmacological treatment for pain
- Deep relaxation
- Releases endorphins
- Physical, mental and emotional comfort
- Improves sleep and eases tense muscles
Aside from the physical response, touch provides the hospice patient with an opportunity for quiet reflection as they focus on the touch experience. These moments of quiet reflection may allow one to recall life’s experiences with a deeper insight into the feelings connected to these memories.
Focused or intentional touch can convey a message of being cared for, being safe, worthwhile and being connected to a greater whole.
Feelings of safety and belonging help the patient develop a more positive relationship with their physical body and in turn with their dying process. This helps ease feelings of anger, depression and fear.
Touch provides the patient with one-on-one social contact and thereby assists in easing feelings of isolation and loneliness. These stressors often contribute to physical and emotional pain.
Easing the stressors that contribute to the experience of pain in conjunction with the stimulation of endorphins makes touch a wonderful partner in controlling pain.
As the hospice patient loses the ability to utilize typical forms of communication, a new means of communication may be established through touch by family, friends and caregivers.
By supporting feelings of emotional safety and easing a portion of the physical and emotional pain experienced by the hospice patient massage/touch may also help ease a bit of the stress that the family and health care team often experience in providing care to the dying.
As the “death positive” movement continues to grow, the inclusion of massage therapy and other complementary therapies are becoming part of the norm in hospice care, rather than the exception.
“One great lesson is dying people are still living. Dying is these final moments of a life, and therefore a very potent, essential, really concentrated part of life. But it’s a part of life. That’s the first lesson… ‘Oh, right. Dying’s part of the deal, and I’m still living when I’m dying.’” ~ BJ Miller
BJ Miller is a hospice and palliative care specialist at UCSF Health. He shares his own story and valuable insight to the dying process in the links below.